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Notes  on  Pathophysiology  of  Carotid  Artery  Disease  
Carotid  artery  disease  is  the  blockage  or  narrowing  of  the  carotid  arteries  due  to  
a  build  up  of  plaque,  this  process  is  otherwise  known  as  stenosis  of  the  carotid  
arteries
...
   
A  normal  carotid  artery  will  have  three  layers;  the  adventitia  is  the  outermost  
layer,  the  middle  layer  or  the  tunica  media  is  the  biggest  layer  as  it  contains  a  lot  
of  smooth  muscle  cells,  and  the  innermost  layer  is  the  tunica  intima  which  is  
lined  by  endothelial  cells
...
 
It  is  hard  to  diagnose  carotid  artery  disease  early  as  symptoms  usually  do  not  
present  until  the  blood  flow  to  the  brain  is  severely  limited,  as  blood  supplies  the  
brain  with  an  essential  continuous  supply  of  oxygen  and  glucose,  the  plaques  
formed  can  crack  or  rupture  which  is  known  as  thrombosis,  and  a  piece  of  
plaque  or  thrombus  can  block  the  smaller  arteries  in  the  brain  and  when  these  
are  narrowed  or  blocked  it  can  cause  a  transient  ischaemic  attack  (TIA),  which  is  
where  the  brain  function  is  temporarily  affected  due  to  the  decrease  in  the  
oxygen  supply,  symptoms  of  this  could  include;  clumsiness,  numbness  in  the  
limbs,  loss  of  vision  and  brief  attacks  of  weakness,  or  the  thrombus  could  cause  a  
stroke  which  is  the  permanent  loss  of  brain  function  caused  by  completed  
blockage  and  carotid  artery  disease  is  the  most  common  cause  of  strokes,  the  
symptoms  of  a  stroke  include;  slurred  speech,  no  control  over  one  side  of  the  
body  and  the  face  may  droop  to  one  side
...
   
The  carotid  sinus  or  bulb  is  usually  the  area  which  would  be  looked  at  first,  as  it  
is  located  just  superior  to  where  the  common  carotid  artery  bifurcates  into  the  
internal  and  external  carotid  arteries  and  therefore  it  is  the  most  common  place  
to  have  a  build  up  of  plaque  forming  due  to  the  turbulent  blood  flow  around  this  
point
...
 
 
Conventional  angiography  is  sometimes  used  to  diagnose  carotid  artery  disease,  
where  the  blood  vessels  are  seen  by  using  a  contrast  medium  that  is  injected  
into  the  femoral  artery  and  then  x-­‐ray  images  of  the  blood  vessels  are  produced,  
however  since  this  is  mainly  an  interventional  procedure  its  carries  some  risk  
and  due  to  the  rapid  improvement  in  magnetic  resonance  tomography  (MR)  and  
computer  assisted  tomography  (CT)  angiographic  technologies,  conventional  
angiography  is  being  used  less  as  a  diagnostic  test
...
 
Another  diagnostic  test  used  is  MR  angiography,  however  this  takes  longer  than  
a  spiral  CT  angiography  and  it  has  been  found  that  the  degree  of  stenosis  can  be  
overestimated  when  MR  angiography  is  used
...
 
Carotid  angioplasty  and  stenting  (CAS)  should  be  reserved  more  for  
symptomatic  patients  with  50%  to  99%  stenosis,  and  for  those  who  are  at  high  
risk  of  complication  from  a  CEA
...
 
A  CEA  can  be  performed  under  a  general  or  local  anaesthetic  and  it  involves  
making  an  incision  vertically  down  the  side  of  the  neck  to  gain  access  to  the  
carotid  artery,  which  is  then  also  cut  and  the  plaque  is  carefully  removed  from  
the  lumen  of  the  artery,  while  this  is  occurring  blood  would  be  shunted  around  
this  area  to  ensure  the  brain’s  blood  supply  is  uninterrupted
...
 
Another  treatment  pathway  considered  for  asymptomatic  patients  in  the  early  
stages  of  carotid  artery  disease  is  medical  therapy;  this  is  the  use  of  drugs  like  
aspirin  or  clopidogrel  to  thin  the  blood  and  prevent  clots  from  forming
...
 
 
 
 
 
 
 
 
 

 



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